ABSTRACT Background and Aims Although GEMA-Na outperforms MELD 3.0 for liver allocation, concerns about the subjectivity of its ascites component persist. We compared the performance of a GEMA-Na iteration that excludes ascites with other allocation scores. Approach and Results A multinational cohort study was conducted, including adult candidates for elective liver transplantation in the UK (2010–2020), Australia (1998–2020), and Spain (2016–2021). The primary outcome was mortality or delisting for sickness within 90days. The prognostic impact of ascites was evaluated using multivariable Cox’s regression. Discrimination was assessed using Harrell’s c-statistics (Hc). The study included 15391 patients (28.5% women). The prevalence of the primary outcome was 5.8% in the UK, 5.3% in Australia, and 4.7% in Spain. The presence and severity of ascites was associated with an incremental risk of the primary outcome: 3.3% without ascites, 5.8% with mild ascites, and 7.7% with moderate–severe ascites (p<0.001). Removal of ascites from the GEMA-Na score resulted in a one-point reduction in 18% of patients (52.4% of patients with moderate–severe ascites). GEMA-Na without ascites showed only a marginal decrease in discrimination (Hc=0.755 vs. Hc=0.753; p=0.007) but still significantly outperformed MELD 3.0 (Hc=0.734; p<0.001) and MELD-Na (Hc=0.737; p<0.001). In women, GEMA-Na with and without ascites demonstrated comparable discrimination (Hc=0.784 vs. Hc=0.783; p=0.61), both outperforming MELD 3.0 (Hc=0.750; p<0.001), and MELD-Na (Hc=0.749; p<0.001). Conclusions Despite the prognostic impact of ascites among liver transplant candidates, GEMA-Na without ascites outperformed other scores in predicting wait-list outcomes and may be used wherever the inclusion of ascites is considered too subjective.